Early noninvasive ventilation in general wards for acute respiratory failure: an international, multicentre, open-label, randomised trial.

Background: The impact of noninvasive ventilation (NIV) managed outside the intensive care unit in patients with early acute respiratory failure remains unclear. We aimed to determine whether adding early NIV prevents the progression to severe respiratory failure.

Methods: In this multinational, randomised, open-label controlled trial, adults with mild acute respiratory failure (arterial oxygen partial pressure/fraction of inspiratory oxygen [Pao/FiO] ratio ≥200) were enrolled across 11 hospitals in Italy, Greece, and Kazakhstan.

Relationship Between the Lateral Collateral Ligament of the Elbow and the Kocher Approach: A Cadaver Study.

Purpose: The lateral ulnar collateral ligament (LUCL) is considered to be the portion of the lateral collateral ligament playing the most important stabilizing role. Iatrogenic forms of posterolateral rotatory instability have been described. The Kocher approach is a popular approach to the lateral side of the elbow.

Outcomes of 188 Proximal Humeral Fractures Treated with a Dedicated External Fixator with Follow-up Ranging from 2 to 12 Years.

Background: The treatment of a displaced proximal humeral fracture is still a matter of controversy. Minimally invasive techniques are considered promising options. The purpose of this study was to report outcomes at medium to long-term follow-up after surgical treatment with pins stabilized with an external fixator.

Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study.

Background: Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time.

Methods: The study included 363 patients.

Results of primary repair of distal triceps tendon ruptures in a general population: a multicentre study.

Aims: The aim of the study was to analyze the results of primary tendon reinsertion in acute and chronic distal triceps tendon ruptures (DTTRs) in the general population.

Patients And Methods: A total of 28 patients were operated on for primary DTTR reinsertions, including 21 male patients and seven female patients with a mean age of 45 years (14 to 76). Of these patients, 23 sustained an acute DTTR and five had a chronic injury.

Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction.

 The aim of the study was to evaluate the "over the top" (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction.  Twenty-four patients with a mean age of 31.9 ± 11.

The Degree of Shoulder Involvement in Sports (DOSIS) scale is a valid and responsive instrumentation for shoulder assessment in patients after surgery for anterior instability.

Purpose: The purpose of this study was to evaluate validity and responsiveness of the Degree of Shoulder Involvement in Sport (DOSIS) scale.

Methods: A web-based survey was developed to test the construct validity of the DOSIS scale. Fifty-three patients with a median age of 33 years (range 17-59) were included in the study.

Chronic knee extensor mechanism lesions in total knee arthroplasty: a literature review.

Knee extensor mechanism rupture is a serious complication of total knee arthroplasty (TKA). Its prevalence ranges from 1 to 10% and it is commonly observed as a chronic multifactorial pathology with the patellar tendon as the most common site of rupture. Knee extensor mechanism reconstruction can be performed using allogenic or synthetic grafts.

Arthroscopic Bankart Repair Versus Open Bristow-Latarjet for Shoulder Instability: A Matched-Pair Multicenter Study Focused on Return to Sport.

Background: The arthroscopic Bankart repair and open Bristow-Latarjet procedure are the 2 most commonly used techniques to treat recurrent shoulder instability.

Purpose: To compare in a case control-matched manner the 2 techniques, with particular emphasis on return to sport after surgery.

Study Design: Cohort study; Level of evidence, 3.

Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder.

Hypothesis: The critical shoulder angle (CSA) could be responsible for cuff tears and concentric osteoarthritis. We aimed to assess this association when potential confounding factors were excluded and to test the hypothesis that more extreme CSAs are associated with larger tears and more severe osteoarthritis.

Methods: The study cohort was composed of 200 patients with primary concentric osteoarthritis (40 patients), isolated supraspinatus tears (40 patients), cuff tears involving at least the supraspinatus and infraspinatus (40 patients), and no history of shoulder problems (control group, 80 patients).

Subclinical hypothyroidism and diabetes as risk factors for postoperative stiff shoulder.

Purpose: Postoperative stiffness can be a disabling condition after arthroscopic shoulder surgery. The purpose of this study was to analyse the potential contribution of subclinical forms of hypothyroidism and diabetes in the development of postoperative shoulder stiffness.

Methods: A prospective study was conducted on 65 consecutive patients scheduled for arthroscopic subacromial decompression or rotator cuff tear repair.

Meniscal Root Tear Repair: Why, When and How?

The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots.

Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction.

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament.

Patellar tendon: From tendinopathy to rupture.

Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol.

Osteocapsular Arthroplasty of the Elbow: Surgical Technique.

Introduction: Arthroscopic osteocapsular arthroplasty of the elbow is a procedure involving three-dimensional reshaping of the bones, removal of any loose bodies, and capsulectomy to restore motion and function as well as to reduce or eliminate pain.

Step 1 Get In And Establish A View: Visualize identifiable articular structures and confirm their anatomic orientation.

Step 2 Create A Space In Which To Work: Remove debris and loose bodies, as well as excise the fat pad and perform a synovectomy as necessary, so that you can see clearly.

Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment.

Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features.

Multidisciplinary investigation in Down syndrome: bear in mind.

Patients who suffer from Down Syndrome may have a number of orthopedic and rheumatologic disorders. Recent life-table study of live-born individuals with Down Syndrome reports a survival rate of >50% to the age of 50. Therefore some osteoporotic-related disorders have to be considered.

Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique.

Posterior shoulder dislocation with humeral head impression fracture is rare and its early diagnosis and treatment remain a challenge for the orthopaedic surgeon. Although literature describes several surgical options, most are based on the detachment of the subscapularis or on more complex techniques that change the humeral joint anatomy even more. This report describes a new operative technique that is only slightly invasive, where the depressed chondral surface is raised to regain a normal articular contour.